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HANNAFORD BROS. CO., LLC
CAH201307-00 MILLINOCKET REGIONAL HOSPITAL
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Covered Entity Details
Entity Name
MILLINOCKET REGIONAL HOSPITAL
Subdivision Name
Type
Critical Access Hospital
340B ID
CAH201307-00
Entity Address
200 SOMERSET STREET
MILLINOCKET, ME 04462
Medicare Provider Number
201307
Participating Start Date
7/1/2011
Last Recertification Date
9/3/2024
Pharmacy Details
Pharmacy Name
HANNAFORD BROS. CO., LLC
Pharmacy Address
DBA HANNAFORD SUPERMARKET & PHARMACY #81
22 GODING AVE
LINCOLN, ME 04457
Pharmacy Comments
Contract Details
Approval Date
7/15/2020
Contract Begin Date
10/1/2020
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Mary K. Martin, VP of Quality
(207) 723-5161 Ext: 370
Contract Pharmacy Representative
Hannaford Bros. Co., LLc
Deanne Sargent, Manager Pharmacy Network & Buisness Development
(207) 885-3044
Signed By Date
7/15/2020
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